• 대한치과마취과학회지
• /
• 제14권1호
• /
• pp.57-62
• /
• 2014

Background: The aim of this study was to analyze outpatient anesthesia for dental treatment in handicapped patients with behavior disorder in order to use data for carrying out better and safe anesthetic management. Methods: The data were drawn from the 100 patients with behavior disorder who visited CNUDH dental clinic for disabled based on anesthesia record to investigate patient's systemic condition, cooperative level, anesthesia method according to patients cooperation, and side effects after recovery time. Results: Mental retardation (58%) is the most reason to choose general anesthesia. The methods of induction according to cooperative level are intravenous propofol injection in 22 cases and inhalation of sevoflurane in 78 cases. Induction time of anesthesia were within 10 seconds in cases of propofol induction and average $48.8{\pm}18.5$ seconds in cases of inhalation induction. The time spent on dental treatment was average $3.2{\pm}1.1$ hours. After the end of treatment, average time to move from unit chair to recovery bed, to recliner, and to discharge from hospital are $10.4{\pm}5.1$, $36.9{\pm}17.1$ and $72.4{\pm}16.0$ minutes, respectively. During recovery, there are nausea with 9%, vomiting with 4%, dizziness with 2%, finger injury with 1%. Conclusions: This study showed our successful anesthetic outcomes without any severe side effects or complications. Through this study, it will be used for safe anesthetic management as useful reference data.

• Journal of Preventive Medicine and Public Health
• /
• 제32권3호
• /
• pp.317-324
• /
• 1999

Objectives: Since 1991, nationwide massive neonatal screening program for phenylketonuria (PKU) and congenital hypothyroidism have been performed in Korea. As in many other countries, efficiency of this program has not been definitely concluded. For the purpose of evaluation of this program, from the perspective of efficiency, a cost-benefit analysis was carried out. Methods: Costs of the detection and the treatment program were compared with the projected benefit(avoided costs) that results from the prevention of the mental retardation associated with the disorders due to PKU and hypothyroidism. Costs and benefits were discounted at an annual rate of 5%, and duration of life-long labor was assumed to be 30 years. Cost and benefit were estimated based on the detection rates of one case of PKU per 5,572 and one case of congenital hypothyroidism per 32,554 babies screened during 1991-1997. Results: The benefit-cost ratio was 0.418. The sensitivity analysis for the discount rates and labor durations showed that most cost-benefit ratios were lower than one(1.0) except when discount rate was changed to 3% and detection rate to two- or threefold and/or labor duration to 40 years. Conclusion: The result of this study suggested that present program of mass screening for PKU and congenital hypothyroidism could not be justified in terms of efficiency. It doesn't coincide with the results of previous studies in major developed countries, presumably because of difference in detection rates and welfare cost for the disabled.

• 기본간호학회지
• /
• 제21권1호
• /
• pp.57-68
• /
• 2014

Purpose: Nurses' management of Nursing Home residents' remaining functional ability is phenomena emphasizing as the main practice focus in long term care and has specific meanings within the context of quality of life for fragile and disabled elderly people in nursing homes. This study was conducted to clarify and to conceptualize the phenomena of nurses' management of nursing home residents' remaining functional ability. Method: The Hybrid Model of concept development was applied to develop a concept of nurses' management of residents' remaining functional ability. Results: This concept of nurse' management emerged as a phenomenon having meanings in two different dimensions, deliberation and enactment for five types of residents: residents with declining function and dementia requiring nursing assistance, bed-ridden residents with moderate dementia, residents with advanced dementia and behavior problems, but good physical health, residents at the end of life stage, and bed-ridden residents with intact mental health. Conclusions: Results indicate that nurses' management of remaining functional ability of residents in nursing homes is a concept having types of needs that should be treated in specified ways. Interventions should have a positive impacts on practical applications in nursing homes and on enhancing residents' remaining function.

• 지역사회간호학회지
• /
• 제15권1호
• /
• pp.56-66
• /
• 2004

Objectives: The purpose of this study was to verify a change for family nursing phenomena and satisfaction of clients of vulnerable families in an urban community. Methods: The study subjects were 711 families, randomly selected, who had chronic diseases(arthritis diabetes, stroke, hypertension, mental disease, cancer, dementia) with basic social welfare services from the nation and had disabled persons in an urban community, South Korea. The instruments used were the family nursing phenomena in Korea by ICNP and client satisfaction. Client satisfaction consisted of client satisfaction on home visiting nurses(4 Likert scales) and home visiting services(3 Likert scales). Results: The average visiting number is 3.82. The service number of education and counseling is 3.16, patient and symptom management 3.08, assessment and diagnosis 3.08, test 2.02, medication service 1.71회, dressing 1.01, referral to social welfare institute 1.00회, referral to medical service institute 0.21. In both, pre home visiting and post home visiting, the highest rated phenomenon was the 'lack of social support system' and following that 'deficit of financial management skill and support'. 'lack of family interaction in community', and 'social isolation' 'unhealthy life style' and 'inadequate care management of sick member', in that order. The percentages of phenomena besides 'deficit of financial management skill and support' decreased. The satisfaction level of clients towards the nurses was 3.27 points on a scale of 4, and the nursing services was 2.70 points on a scale of 3. Conclusion: Home visiting nursing services should continue to provide comprehensive healthcare services and support for vulnerable families, in urban communities.

• 보건행정학회지
• /
• 제10권4호
• /
• pp.99-115
• /
• 2000

This study was conducted to get a resonable set of budget allocation to public health programs. Matrix Delphi technique was used to obtain the logic of study results and eventually to form a human model which could predict opinion of professionals on budget allocation. Thirty-two professionals in academic and governmental area responded to Delphi survey. Questionnaire was developed using matrix formation, and the matrix was formed by 6 decision criteria on budget allocation and 26 public health programs. The decision criteria are as following: size of problem(morbidity), severity of problem, social equity, importance of prevention, technical feasibility and efficiency of programs. Severity of problem dropped out of the model because it had significant correlation with the size of problem. A total score of each program was obtained by weighting the relative importance of each criteria which also were given by survey respondents. These total scores indicate that the most important public health program is vaccination for infants and children in terms of budget allocation. Monitoring communicable diseases, mental health program, and anti-smoking program are the next. In addition, respondents were asked of the desirable budget size of each program. The result was rearranged by multiple regression model using the scores of each decision criteria. In this process, the current budget size of central government was provided to the respondents, and included in the model. h set of desirable budgets modified using tile model was obtained. Considering the current size of budget, tile results of the model is very different from that of the total score. Managing dementia is ranked the first. Health promotion program for the elderly, rehabilitation of the disabled and monitoring communicable diseases are the next. The need to increase the budget of vaccination for the infants and children was not found as so high. The matrix structure in Delphi survey gave us the precise basis to make optimal decision, and made it possible to develop an opinion predicting model. However the plentifulness and diversity of professional opinions were not fully obtained due to the limited number of decision criteria.

• 한국전문물리치료학회지
• /
• 제14권1호
• /
• pp.74-81
• /
• 2007

The purpose of this study was to investigate effect of hospital-based physical and occupational therapy on Modified Barthel Index (MBI) score in stroke inpatients at least 3 months after stroke, to predict MBI score at discharge from subscales of MBI, and determine the characteristics of stroke at admission. Forty-five stroke inpatients participated and received physical and occupational therapy for two months. All participants were assessed on MBI at admission and discharge. The collected data was analyzed by dependency level (MBI${\leq}$74 and MBI${\geq}$75) at admission. The results revealed that the MBI score at discharge was significantly improved compared to the MBI score at admission in the group with more than moderate dependency level (MBI${\leq}$74). In particular, personal hygiene, dressing, ambulation, and chair/bed transfer were improved. But only ambulation was improved significantly in the group with a less than mild dependency level (MBI${\geq}$75). The chair/bed transfer, dressing, ambulation, and Mini-Mental State Exam-Korea score at admission were important factors in the MBI score at discharge. Eighty-six percent of the variation in MBI score function at discharge can be explained. Therefore, it is suggested that hospital-based physical and occupational therapy in subacute stroke improve independent living status, especially for patients with a more than moderate dependency level.

• 한국사회복지학
• /
• 제65권1호
• /
• pp.5-31
• /
• 2013

본 연구는 WHO의 국제건강관련분류체계인 ICF를 적용하여, 한국의 근골격계질환 장애인(척수손상, 근육디스트로피, 왜소증, 류마티즘) 352명의 사회참여 관련요인을 분석하였다. 연구방법은 기술분석, 집단별 평균분석 및 분산분석과 사후검정, 단순상관분석, 다중회귀분석을 사용하였다. 연구결과 근골격계질환 장애인의 정신기능, 신경근육골격 및 운동과 연관된 기능, 비뇨생식기와 생식기능, 피부 및 관련구조, 학습과 지식 적용, 일반적 과제와 요구, 이동의 수준이 높을수록 사회참여의 수준도 높았다. 개인요인에서 소득이 근육디스트로피질환 장애인의 사회참여 관련요인으로 나타났고, 환경요인에서 서비스, 시스템 및 정책이 척수손상 장애인의 사회참여에 영향을 미치는 것으로 나타났다. 본 연구는 장애에 관한 보편주의적 접근을 의미하는 ICF 구성요소로 연구모형을 설정하고, ICF 코어셋을 검토하여 질환관련범주를 측정하였다는 점에 의의가 있다.

• 대한치과마취과학회지
• /
• 제11권2호
• /
• pp.146-152
• /
• 2011

Background: Elderly patients with progressive dementia including Alzheimer's disease (AD) are more and more often scheduled to undergo general anesthesia for various pathologies including dental problem. But, there is high risk of deterioration of underlying mental diseases and other co-morbidities. So it is important to implement preventive strategies and take adequate measures to minimize negative perioperative events in these patients. Methods: We reviewed the 17 cases of 11 patients with AD who underwent ambulatory general anesthesia for dental treatment at the clinic for the disabled in Seoul National University Dental Hospital. Results: The mean age was 68 (57-81) years. All of them were diagnosed with AD and some had hypertsnsion, bronchiectasis, urinary incontinence. For anesthesia induction, 3 cases (1 patient) was needed physical restraint, but others showed good or moderate cooperation. Drugs used for anesthesia induction was thiopental (11 cases), propofol (3 cases) and sevoflurane (3 cases). All patients received nasotracheal intubation without difficulties. Mean total anesthetic time was 3 hour 44 min ${\pm}$ 60 min and staying time at PACU was 83 ${\pm}$ 34 min. All the patients except one who showed hypertension discharged without any complication. There was no death or long term hospitalization because of severe complications. Conclusions: If general anesthesia is needed, pertinent diagnostic tests and workup about other medical problems, and appropriate anesthetic planning are essential for safety.

• 재활복지
• /
• 제21권3호
• /
• pp.49-63
• /
• 2017

본 연구는 장기요양시설에 거주하는 노인의 기능장애가 자아통합감과 우울에 미치는 영향을 파악하고, 기능장애와 우울과의 관계에서 자아통합감의 매개효과를 분석하기 위해, D지역과 K지역에 위치한 장기요양시설 거주 노인 247명을 대상으로 설문조사를 실시하였다. 수집된 자료는 SPSS 21.0을 이용하여 분석하였으며, 분석결과, 장기요양시설 노인의 일상생활수행장애와 도구적 일상생활수행장애는 우울과 정적으로 유의한 관계를 가지는 반면, 자아통합감과는 부적 관계를 가지는 것으로 나타났다. 또한, 노인의 연령, 경제수준, 요양등급을 통제한 후, 기능장애가 자아통합감과 우울에 미치는 영향을 분석한 결과, 기능장애는 자아통합감과 우울에 유의한 영향을 미치는 것으로 제시되었으며, 자아통합감은 기능장애와 우울에 통계적으로 유의한 부분매개효과를 가지는 것으로 제시되었다. 이러한 연구결과바탕으로, 장기요양시설 노인의 기능장애와 자아통합감과 관련된 정신건강 증진을 위한 함의 및 후속연구를 위한 방향을 제시하였다.

• Journal of Yeungnam Medical Science
• /
• 제38권2호
• /
• pp.127-135
• /
• 2021

Background: Dialysis patients are prone to having disabilities. We aimed to evaluate the association between disability and various clinical outcomes in Korean dialysis patients. Methods: This study consisted of 1,615 dialysis patients from 27 centers. We evaluated disability by using four questions on the activities of daily living (ADLs) concerning whether help was needed for feeding, dressing/undressing, getting in/out of bed, or taking a bath/shower. We divided the patients into three groups: no disability (Non-D, none of the four ADL domains required help; n=1,312), mild disability (Mild-D, one ADL domain required some/full help; n=163), or moderate to severe disability (MS-D, two or more ADL domains required some/full help; n=140). We evaluated falls, frailty, health-related quality of life (HRQoL), mortality, and hospitalization. Results: The numbers of participants with a fall during the last 1 year were 199 (15.2%), 42 (25.8%), and 44 (31.4%) in the Non-D, Mild-D, and MS-D groups, respectively (p<0.001). The numbers of participants with frailty in the Non-D, Mild-D, and MS-D groups were 381 (29.0%), 84 (51.5%), and 93 (66.4%), respectively (p<0.001). In both univariate and multivariate analyses, the physical component scale and mental component scale scores decreased as the grade of disability increased (p<0.001 for both scores). Hospitalization-free survival rate at 500 days was 64.2%, 56.7%, and 51.1% in the Non-D, Mild-D, and MS-D, respectively (p=0.001 for trend). Patient survival rate at 500 days was 95.3%, 89.5%, and 92.3% in the Non-D, Mild-D, and MS-D, respectively (p=0.005 for trend). Conclusion: Disability was associated with falls, frailty, HRQoL scales, and survival trends in Korean dialysis patients.